So, I was talking to my girl a few months back; we’ll call her Prada* for now. She was telling me that she isn’t on PrEP because one of the other girls was tellin’ her that it will mess with her ‘mones (hormones), and she ain’t have time for all of that. As a PrEP Navigator, I felt silly for not having this answer on deck and RET to GO. I had to go ask my doctor-friends and do some reading on how — or even IF — PrEP can affect the feminizing hormones that transwomen (the girls) take.

This is a question that a lot of the girls ask; will PrEP affect my hormones? This is a pretty simple question, and one would think that answer would be simple—it is…kind of.

PrEP doesn’t affect the efficacy of hormones, no, but feminization hormone therapy (FHT) can affect PrEP, specifically tenofovir, one of the medications in PrEP.

Here is where it gets frustrating; scientists have discovered that FHT can lower the amount of tenofovir available in the bloodstream by 13% (PRN 2020). This complicates things. While taking PrEP while not affect hormones or slow down/lower feminizing hormones, it can lower the effectiveness of PrEP, but scientists are unsure what the efficacy levels become (it isn’t subtracting from efficacy levels, just levels in the blood). The levels that were measured in trans women using estradiol were “still above the target level shown to confer protection in previous studies” (PRN 2020). What does this mean?

Keep taking PrEP. Transwomen, like ciswomen, need to be even more vigilant to keep their PrEP levels up to a protective level. PrEP won’t affect hormones, but hormones slightly affect PrEP. The iFACT study of PrEP and transwomen as stated that “it is not known whether this difference in blood levels correlates with tenofovir levels in rectal tissue [important if having receptive anal sex], where HIV exposure typically occurs” (PRN 2020).

In an article by The Body Pro, they stated one study from the medical journal AIDS and Behavior (Ajree 2018):

“…between 2012 and 2015, only one in three trans women in Boston and Chicago were aware of PrEP, and only one in four found PrEP to be acceptable to use. No changes in the proportion of awareness were observed over these years. Furthermore, only 5% of the 300 trans women in the study reported ever taking PrEP. Similarly, in studies conducted in Brazil and Thailand, only a small portion of trans women found PrEP to be acceptable and initiated use.”

PrEP use among transwomen remains unacceptably low despite being safe for use and NOT affecting hormones. It is on us, the HIV community of professionals, to do the work to reach transwomen and inform people of the risks and rewards of using PrEP (hint: there is MUCH more reward than risk).

Let me keep it all the way 100

I know. I know. This isn’t particularly precise language.

The truth is we are behind the times. The scientific research communities have advocated for LGB, especially TQIA research, but the process is slow as science itself can be. It isn’t right or fair, nor is it right that most data lumps trans people in with their gender assigned at birth.

Luckily, more studies are coming out every year, and advancement is happening. The science is ever-evolving, and as we learn more, we will have more to share.

I wish this blog could be more. Just more. More informative. More exact. More impactful, but this is all we have to share right now until more recent data surfaces — but this is very useful. The bottom line is NO; PrEP will NOT affect your hormone levels.

What we do know

Since PrEP does not lower hormones, you can do both. Just make sure you are taking your PrEP and your hormones as directed! It is better to have protection than listen to rumors that keep you unprotected, girl. No need to avoid PrEP because of hormones. Make an appointment and get yo’ PrEP, sis!

Have more PrEP questions?

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